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Nerve Blocks

:confused:New at this, I had a coder put in 64405, but I believe this should be 64490, anyone please help understand..:confused:

Third Occipital Nerve Block, Cervical Spine Medial Branch Nerve Block
*
Pre-operative diagnosis:
* * ICD-10-CM
1. Occipital neuralgia of right side M54.81
*
Post-operative diagnosis: same
Procedure: right Cervical Spine C2-3 Medial Branch Nerve/Third occipital nerve block between C2-3 (facet) under fluoroscopic guidance
*
Indications: This patient has a diagnosis of neck pain due to Occipital neuralgia/headache, Cervicogenic headache and cervical spine spondylosis. Informed consent obtained after explaining the procedure and potential complications including local discomfort, infection, headache, temporary or permanent weakness and/or numbness of one or both legs, temporary or permanent paraplegia, heart attack and stroke. All questions were answered.
*
Procedure in detail:
Patient was taken to the procedure room and placed in prone position. Time out was performed. Patient’s right lateral neck/cervical spine area was prepped with Chloraprep and draped in a sterile manner.
*
Then, lateral fluoroscopy was used to identify and mark the the center of the C2-3 facet joint on the right side. Additionally, the midpoint of the mid-articular pillars at C2-3 on the right were also marked. Then, under lateral fluoroscopic guidance, a 25 G 3.5 inch spinal needle, was advanced to the targeted points corresponding with the locations of the third occipital nerve.
*
Then, after negative aspiration for heme and injection of total 1 ml of Omnipaque contrast, Total 1 mL of lidocaine 1% and 40 mg depomedrol was injected at the target point corresponding to the locations of the third occipital nerve.
*
Needle was removed and bandaged placed over site of needle insertion.
*
Estimated Blood Loss: None
Specimens: None
Disposition: The patient tolerated the procedure without complaint and was transported to the recovery room in stable condition.
Follow-up: The patient will return as scheduled

Medical Billing and Coding Forum

finger amputation/biopsy/Peripheral nerve block

Please !!!

could some one help with coding below, should I code Biopsy with Peripheral nerve block ? do I need any modifier?

PREOPERATIVE DIAGNOSES:
1. Right middle finger necrosis.
2. Right middle finger infection.

POSTOPERATIVE DIAGNOSES:
1. Right middle finger necrosis.
2. Right middle finger infection.

PROCEDURES:
1. Right middle finger irrigation and debridement of open wound.
2. Right middle finger neurectomy of radial and ulnar digital nerve.
3. Right middle finger amputation at proximal interphalangeal joint.
Code 26952

4. Peripheral nerve block radial nerve and the proper median
nerves
Code 64450

5. Biopsy: Profundus and superficialis tendons
were retracted and cut. The extensor tendon was then cut as well. The PIP
joint was disarticulated

bipsy code 26110

6. Fluoroscopic exam

Thank you

Medical Billing and Coding Forum

CPT for Reanastomosis of LT recurrent laryngeal nerve

I would appreciate any help regarding the CPT for Reanastomosis of LT recurrent laryngeal nerve as I can not find anything for it.

Doctor performed
1. Left total thyroid lobectomy (60220)
2. Reanastomosis of left recurrent laryngeal nerve (?)
3. Reimplantation of left superior parathyroid gland (60512)

FINDINGS: Left recurrent laryngeal nerve transected, and primary reanastomosis
performed, left superior parathyroid gland devascularized and reimplanted into
the left sternocleidomastoid muscle and marked with Hemoclips, thyroid gland
enlarged, multinodular, hypervascular and inflamed.

…The gland was very hypervascular multinodular and inflamed, very adherent to surrounding structures. The
recurrent laryngeal nerve was found to be coursing over the anterior aspect of the thyroid gland itself and this was transected while dissecting along the thyroid capsule. The 2 ends of the recurrent laryngeal nerve were identified and tagged. A superior
parathyroid gland was identified and its blood supply was preserved, however, during the case, the thyroid was so hypervascular, this was devascularized while obtaining hemostasis. Therefore, the superior parathyroid gland was removed and morcellized and placed back into the sternocleidomastoid muscle on the left at the end of the case. The typical location of the recurrent laryngeal nerve was dissected carefully and there was no nerve of note in this location; however, the distal end of the recurrent laryngeal nerve was found to be entering into the cricothyroid joint and at this point, it was recognized that the abnormal course of the recurrent laryngeal nerve coursing over the anterior aspect of the thyroid lobe was in fact the recurrent laryngeal nerve. The
left thyroid gland was completely removed using Bovie cautery to divide Berry’s ligament and bipolar cautery to divide the isthmus. The left thyroid gland was handed off and the 2 tagged ends of the left recurrent laryngeal nerve were reanastomosed using 9-0 nylon. There was not undue tension on the nerve at this point. There was no identifiable parathyroid tissue on the specimen.

TIA
KM

Medical Billing and Coding Forum

Nerve block spanning thoracic and lumbar levels

We are having a debate in the office and I was hoping to find some assistance here.

If a facet nerve block (64490-64495) or ablation spans two spinal regions, since the description in the additional level CPT codes indicate the regions (ie 64491-64492 indicate cervical or thoracic and 64494-64495 indicate lumbar or sacral), does that mean, you would jump to the primary code of the next spinal region for the additional levels?

For example, T11-L2 facet nerve block. Would it be 64490 for T11-12, 64491 for T12-L1, & 64493 for L1-2 or should the L1-2 be coded as 64492?

The only guideline I can find is in the NCCI where it talks about procedures done at contiguous spine levels but it mentions if the additional level code doesn’t indicate the spine region that you would use the add on code rather than another primary code.

Thanks!

Medical Billing and Coding Forum

Nerve Conduction Studies and EMG

Has anyone had the following deny do to medical necessity? I have verified that the all the dx codes used are on the current Medicare LCD and have checked using Encorder Pro that there are no CCI edits. However, these claims keep rejecting. I am on the phone with Medicare right now waiting to get a straight answer. Any help would be appreciated.

95911 (one unit and no modifier)
95886 (one unit and no modifier)

Medical Billing and Coding Forum

Correct billing for a Micro implatanable Sacral Nerve Stimulator

Unique tiny sacral nerve stimulator billing question:

This is a percutaneous implantable micro stimulator device w/o battery, no leads need to be connected, no pulse generator pocket needs to be created.
Powered externally.

The device is considered to be an all-in-one, Micro implant with integrated circuit (IC) for pulse control, and electrodes, entirely assembled within a 2-mm diameter, 3.5-mm height device small enough to fit inside a catheter.

If the electrodes and the generator are all inside the device, and the physician makes an incision for insertion by an introducer needle, would we bill both the following?:
• 64561 Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed -and-
• 64590 Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling

Basic procedure micro-implant for Sacral Nerve Stimulation:

o Physician uses scalpel to do a very small starter incision adjacent to the needle, followed by insertion of an introducer/dilator/sheath.

o Both the dilator and needle are then withdrawn providing clear access to the target anatomy just adjacent to the sacral nerve.

o All-in-one device is placed adjacent to the sacral nerve by advancing it through the sheath. Physician has the option of using fluoroscopy throughout this procedure as tooling and implant are radiopaque

Any advice is greatly appreciated!:confused:

Medical Billing and Coding Forum